Monday, March 15, 2010

This really makes for a hilarious read. Read on my instapaper today. Just to share.

MARRY HIM!

THE CASE FOR SETTLING FOR MR. GOOD ENOUGH

By Lori Gottlieb
Illustration by Lou Brooks

See web-only content: http://www.theatlantic.com/magazine/archive/2008/03/marry-him/6651/
About six months after my son was born, he and I were sitting on a blanket at the park with a close friend and her daughter. It was a sunny summer weekend, and other parents and their kids picnicked nearby—mothers munching berries and lounging on the grass, fathers tossing balls with their giddy toddlers. My friend and I, who, in fits of self-empowerment, had conceived our babies with donor sperm because we hadn’t met Mr. Right yet, surveyed the idyllic scene.

“Ah, this is the dream,” I said, and we nodded in silence for a minute, then burst out laughing. In some ways, I meant it: we’d both dreamed of motherhood, and here we were, picnicking in the park with our children. But it was also decidedly not the dream. The dream, like that of our mothers and their mothers from time immemorial, was to fall in love, get married, and live happily ever after. Of course, we’d be loath to admit it in this day and age, but ask any soul-baring 40-year-old single heterosexual woman what she most longs for in life, and she probably won’t tell you it’s a better career or a smaller waistline or a bigger apartment. Most likely, she’ll say that what she really wants is a husband (and, by extension, a child).

To the outside world, of course, we still call ourselves feminists and insist—vehemently, even—that we’re independent and self-sufficient and don’t believe in any of that damsel-in-distress stuff, but in reality, we aren’t fish who can do without a bicycle, we’re women who want a traditional family. And despite growing up in an era when the centuries-old mantra to get married young was finally (and, it seemed, refreshingly) replaced by encouragement to postpone that milestone in pursuit of high ideals (education! career! but also true love!), every woman I know—no matter how successful and ambitious, how financially and emotionally secure—feels panic, occasionally coupled with desperation, if she hits 30 and finds herself unmarried.

VIDEO: Lori Gottlieb explains why women should stop holding out for Mr. Right
Oh, I know—I’m guessing there are single 30-year-old women reading this right now who will be writing letters to the editor to say that the women I know aren’t widely representative, that I’ve been co-opted by the cult of the feminist backlash, and basically, that I have no idea what I’m talking about. And all I can say is, if you say you’re not worried, either you’re in denial or you’re lying. In fact, take a good look in the mirror and try to convince yourself that you’re not worried, because you’ll see how silly your face looks when you’re being disingenuous.

Whether you acknowledge it or not, there’s good reason to worry. By the time 35th-birthday-brunch celebrations roll around for still-single women, serious, irreversible life issues masquerading as “jokes” creep into public conversation: Well, I don’t feel old, but my eggs sure do! or Maybe this year I’ll marry Todd. I’m not getting any younger! The birthday girl smiles a bit too widely as she delivers these lines, and everyone laughs a little too hard for a little too long, not because we find these sentiments funny, but because we’re awkwardly acknowledging how unfunny they are. At their core, they pose one of the most complicated, painful, and pervasive dilemmas many single women are forced to grapple with nowadays: Is it better to be alone, or to settle?

My advice is this: Settle! That’s right. Don’t worry about passion or intense connection. Don’t nix a guy based on his annoying habit of yelling “Bravo!” in movie theaters. Overlook his halitosis or abysmal sense of aesthetics. Because if you want to have the infrastructure in place to have a family, settling is the way to go. Based on my observations, in fact, settling will probably make you happier in the long run, since many of those who marry with great expectations become more disillusioned with each passing year. (It’s hard to maintain that level of zing when the conversation morphs into discussions about who’s changing the diapers or balancing the checkbook.)

Obviously, I wasn’t always an advocate of settling. In fact, it took not settling to make me realize that settling is the better option, and even though settling is a rampant phenomenon, talking about it in a positive light makes people profoundly uncomfortable. Whenever I make the case for settling, people look at me with creased brows of disapproval or frowns of disappointment, the way a child might look at an older sibling who just informed her that Jerry’s Kids aren’t going to walk, even if you send them money. It’s not only politically incorrect to get behind settling, it’s downright un-American. Our culture tells us to keep our eyes on the prize (while our mothers, who know better, tell us not to be so picky), and the theme of holding out for true love (whatever that is—look at the divorce rate) permeates our collective mentality.

Even situation comedies, starting in the 1970s with The Mary Tyler Moore Show and going all the way to Friends, feature endearing single women in the dating trenches, and there’s supposed to be something romantic and even heroic about their search for true love. Of course, the crucial difference is that, whereas the earlier series begins after Mary has been jilted by her fiancé, the more modern-day Friends opens as Rachel Green leaves her nice-guy orthodontist fiancé at the altar simply because she isn’t feeling it. But either way, in episode after episode, as both women continue to be unlucky in love, settling starts to look pretty darn appealing. Mary is supposed to be contentedly independent and fulfilled by her newsroom family, but in fact her life seems lonely. Are we to assume that at the end of the series, Mary, by then in her late 30s, found her soul mate after the lights in the newsroom went out and her work family was disbanded? If her experience was anything like mine or that of my single friends, it’s unlikely.

And while Rachel and her supposed soul mate, Ross, finally get together (for the umpteenth time) in the finale of Friends, do we feel confident that she’ll be happier with Ross than she would have been had she settled down with Barry, the orthodontist, 10 years earlier? She and Ross have passion but have never had long-term stability, and the fireworks she experiences with him but not with Barry might actually turn out to be a liability, given how many times their relationship has already gone up in flames. It’s equally questionable whether Sex and the City’s Carrie Bradshaw, who cheated on her kindhearted and generous boyfriend, Aidan, only to end up with the more exciting but self-absorbed Mr. Big, will be better off in the framework of marriage and family. (Some time after the breakup, when Carrie ran into Aidan on the street, he was carrying his infant in a Baby Björn. Can anyone imagine Mr. Big walking around with a Björn?)

When we’re holding out for deep romantic love, we have the fantasy that this level of passionate intensity will make us happier. But marrying Mr. Good Enough might be an equally viable option, especially if you’re looking for a stable, reliable life companion. Madame Bovary might not see it that way, but if she’d remained single, I’ll bet she would have been even more depressed than she was while living with her tedious but caring husband.

What I didn’t realize when I decided, in my 30s, to break up with boyfriends I might otherwise have ended up marrying, is that while settling seems like an enormous act of resignation when you’re looking at it from the vantage point of a single person, once you take the plunge and do it, you’ll probably be relatively content. It sounds obvious now, but I didn’t fully appreciate back then that what makes for a good marriage isn’t necessarily what makes for a good romantic relationship. Once you’re married, it’s not about whom you want to go on vacation with; it’s about whom you want to run a household with. Marriage isn’t a passion-fest; it’s more like a partnership formed to run a very small, mundane, and often boring nonprofit business. And I mean this in a good way.

I don’t mean to say that settling is ideal. I’m simply saying that it might have gotten an undeservedly bad rap. As the only single woman in my son’s mommy-and-me group, I used to listen each week to a litany of unrelenting complaints about people’s husbands and feel pretty good about my decision to hold out for the right guy, only to realize that these women wouldn’t trade places with me for a second, no matter how dull their marriages might be or how desperately they might long for a different husband. They, like me, would rather feel alone in a marriage than actually be alone, because they, like me, realize that marriage ultimately isn’t about cosmic connection—it’s about how having a teammate, even if he’s not the love of your life, is better than not having one at all.

The couples my friend and I saw at the park that summer were enviable but not because they seemed so in love—they were enviable because the husbands played with the kids for 20 minutes so their wives could eat lunch. In practice, my married friends with kids don’t spend that much time with their husbands anyway (between work and child care), and in many cases, their biggest complaint seems to be that they never see each other. So if you rarely see your husband—but he’s a decent guy who takes out the trash and sets up the baby gear, and he provides a second income that allows you to spend time with your child instead of working 60 hours a week to support a family on your own—how much does it matter whether the guy you marry is The One?

It’s not that I’ve become jaded to the point that I don’t believe in, or even crave, romantic connection. It’s that my understanding of it has changed. In my formative years, romance was John Cusack and Ione Skye in Say Anything. But when I think about marriage nowadays, my role models are the television characters Will and Grace, who, though Will was gay and his relationship with Grace was platonic, were one of the most romantic couples I can think of. What I long for in a marriage is that sense of having a partner in crime. Someone who knows your day-to-day trivia. Someone who both calls you on your bullshit and puts up with your quirks. So what if Will and Grace weren’t having sex with each other? How many long- married couples are having much sex anyway?

“I just want someone who’s willing to be in the trenches with me,” my single friend Jennifer told me, “and I never thought of marriage that way before.” Two of Jennifer’s friends married men who Jennifer believes aren’t even straight, and while Jennifer wouldn’t have made that choice a few years back, she wonders whether she might be capable of it in the future. “Maybe they understood something that I didn’t,” she said.

What they understood is this: as your priorities change from romance to family, the so-called “deal breakers” change. Some guys aren’t worldly, but they’d make great dads. Or you walk into a room and start talking to this person who is 5’4” and has an unfortunate nose, but he “gets” you. My long-married friend Renée offered this dating advice to me in an e-mail:

I would say even if he’s not the love of your life, make sure he’s someone you respect intellectually, makes you laugh, appreciates you … I bet there are plenty of these men in the older, overweight, and bald category (which they all eventually become anyway).
She wasn’t joking.

A number of my single women friends admit (in hushed voices and after I swear I won’t use their real names here) that they’d readily settle now but wouldn’t have 10 years ago. They believe that part of the problem is that we grew up idealizing marriage—and that if we’d had a more realistic understanding of its cold, hard benefits, we might have done things differently. Instead, we grew up thinking that marriage meant feeling some kind of divine spark, and so we walked away from uninspiring relationships that might have made us happy in the context of a family.

All marriages, of course, involve compromise, but where’s the cutoff? Where’s the line between compromising and settling, and at what age does that line seem to fade away? Choosing to spend your life with a guy who doesn’t delight in the small things in life might be considered settling at 30, but not at 35. By 40, if you get a cold shiver down your spine at the thought of embracing a certain guy, but you enjoy his company more than anyone else’s, is that settling or making an adult compromise?

Take the date I went on last night. The guy was substantially older. He had a long history of major depression and said, in reference to the movies he was writing, “I’m fascinated by comas” and “I have a strong interest in terrorists.” He’d never been married. He was rude to the waiter. But he very much wanted a family, and he was successful, handsome, and smart. As I looked at him from across the table, I thought, Yeah, I’ll see him again. Maybe I can settle for that. But my very next thought was, Maybe I can settle for better. It’s like musical chairs—when do you take a seat, any seat, just so you’re not left standing alone?

Back when I was still convinced I’d find my soul mate, I did, although I never articulated this, have certain requirements. I thought that the person I married would have to have a sense of wonderment about the world, would be both spontaneous and grounded, and would acknowledge that life is hard but also be able to navigate its ups and downs with humor. Many of the guys I dated possessed these qualities, but if one of them lacked a certain degree of kindness, another didn’t seem emotionally stable enough, and another’s values clashed with mine. Others were sweet but so boring that I preferred reading during dinner to sitting through another tedious conversation. I also dated someone who appeared to be highly compatible with me—we had much in common, and strong physical chemistry—but while our sensibilities were similar, they proved to be a half-note off, so we never quite felt in harmony, or never viewed the world through quite the same lens.

Now, though, I realize that if I don’t want to be alone for the rest of my life, I’m at the age where I’ll likely need to settle for someone who is settling for me. What I and many women who hold out for true love forget is that we won’t always have the same appeal that we may have had in our 20s and early 30s. Having turned 40, I now have wrinkles, bags under my eyes, and hair in places I didn’t know hair could grow on women. With my nonworking life consumed by thoughts of potty training and playdates, I’ve become a far less interesting person than the one who went on hiking adventures and performed at comedy clubs. But when I chose to have a baby on my own, the plan was that I would continue to search for true connection afterward; it certainly wasn’t that I would have a baby alone only to settle later. After all, wouldn’t it have been wiser to settle for a higher caliber of “not Mr. Right” while my marital value was at its peak?

Those of us who choose not to settle in hopes of finding a soul mate later are almost like teenagers who believe they’re invulnerable to dying in a drunk-driving accident. We lose sight of our mortality. We forget that we, too, will age and become less alluring. And even if some men do find us engaging, and they’re ready to have a family, they’ll likely decide to marry someone younger with whom they can have their own biological children. Which is all the more reason to settle before settling is no longer an option.

I’ll be the first to admit that there’s something objectionable about making the case for settling, because it’s based on the premise that women’s biological clocks place them at the mercy of men, and that therefore a power dynamic dictates what should be an affair solely of the heart (not the heart and the ovaries). But I’m not the only woman who accepts settling as a valid choice—apparently so do the millions who buy bestselling relationship books that advocate settling but that, so as not to offend, simply spin the concept as a form of female empowerment.

Take, for instance, books like Men Are Like Fish: What Every Woman Needs to Know About Catching a Man or Find a Husband After 35 Using What I Learned at Harvard Business School, whose titles alone make it clear that today’s supposedly progressive bachelorettes aren’t waiting for old-fashioned true love to strike before they can get married. Instead, they’re buying dozens of proactive coaching manuals to learn how to strategically land a man. The actual man in question, though, seems so irrelevant that, to my mind, these women might as well grab a well-dressed guy off the street, drag him into the nearest bar, buy him a drink, and ask him to marry her. (Or, to retain her “power,” she should manipulate him into asking her.)

The approaches in these books may differ, but the message is the same: more important than love is marriage. To achieve that goal, women across the country are poring over guidebooks that all boil down to determining, “Does he like me?,” while completely overlooking the equally essential question, “Do I like him?” In other words, whatever compromises you have to make—including, but not limited to, pretending to be or actually becoming an entirely different person—make sure that you get some schmo to propose to you before you turn into a spinster.

Last year’s Why Smart Men Marry Smart Women makes the most blatant case for settling: if women were more willing to “think outside the box,” as one of the book’s married sources advises, many of them would be married. The author then trots out tales of professional, accomplished women happily dating a plumber, a park ranger, and an Army helicopter nurse. The moral is supposed to be “Don’t be too picky” but many of the anecdotes quote women who seem to be trying to convince not just the reader, but themselves, that they haven’t settled.

“I should be with some guy with a vast vocabulary who is very smart,” said Heather, a 30-year-old lawyer turned journalist. Instead, she’s dating an actor who didn’t finish college. “My boyfriend is fun, he’s smart, but he hasn’t gone through years of school. He wanted to pursue acting. And you can tell—he doesn’t have that background, and it never ever once bothered me. But for everyone else, [his lack of education] is what they see.” Another woman says she dates “the ‘secrets’ … guys other women don’t recognize as great.” How’s that for damning praise?

Meanwhile, in sugarcoating this message, the authors often resort to flattery, telling the reader to remember how fabulous, attractive, charming, and intelligent she is, in the hopes that she’ll project a more confident vibe on dates. In my case, though, the flattery backfired. I read these books thinking, Wait, if I’m such a great catch, why should I settle for anyone less than my equal? If I’m so fabulous, don’t I deserve true romantic connection?

Only one popular book that I can think of in the vast “find a man” genre (like most single women confounded by their singleness, I’m embarrassingly well versed) takes the opposite approach. In He’s Just Not That Into You, written by the happily married Greg Behrendt and the unhappily single Liz Tuccillo, the duo exhorts women not to settle. But the book’s format is telling: Behrendt gives perky pep talks to women unable to find a worthy match, while Tuccillo repeatedly comments on how hard it is to take her co-author’s advice, because while being with a partner who is “beneath you” (Behrendt’s term) is problematic, being single just plain “sucks” (Tuccillo’s term).

Before I got pregnant, though, I also read single-mom books such as Choosing Single Motherhood: The Thinking Woman’s Guide, whose chapter titles “Can I Afford It?” and “Dealing With the Stress” seemed like realistic antidotes to the faux-empowering man-hunting manual headings like “A Little Lingerie Can Go a Long Way.” But the book’s author, Mikki Morrissette, held out a tantalizing carrot. In her introduction, she describes having a daughter on her own; then, she writes, a few years later and five months pregnant with her son, “I met a guy I fell in love with. He and my daughter were in the delivery room when my son was born in January 2004.” Each time I read about single women having babies on their own and thriving instead of settling for Mr. Wrong and hiring a divorce lawyer, I felt all jazzed and ready to go. At the time, I truly believed, “I can have it all—a baby now, my soul mate later!”

Well … ha! Hahahaha. And ha.

Just as the relationship books fail to mention what happens after you triumphantly land a husband (you actually have to live with each other), these single-mom books fail to mention that once you have a baby alone, not only do you age about 10 years in the first 10 months, but if you don’t have time to shower, eat, urinate in a timely manner, or even leave the house except for work, where you spend every waking moment that your child is at day care, there’s very little chance that a man—much less The One—is going to knock on your door and join that party.

They also gloss over the cost of dating as a single mom: the time and money spent on online dating (because there are no single men at toddler birthday parties); the babysitter tab for all those boring blind dates; and, most frustrating, hours spent away from your beloved child. Even women who settle but end up divorced might be in a better position than those of us who became mothers on our own, because many ex-wives get both child-support payments and a free night off when the kids go to Dad’s house for a sleepover. Never-married moms don’t get the night off. At the end of the evening, we rush home to pay the babysitter, make any houseguest tiptoe around and speak in a hushed voice, then wake up at 6 a.m. at the first cries of “Mommy!”

Try bringing a guy home to that.

Settling is mostly a women’s game. Men settle far less often and, when they do, they don’t seem the least bit bothered by the fact that they’re settling.

My friend Alan, for instance, justified his choice of a “bland” wife who’s a good mom but with whom he shares little connection this way: “I think one-stop shopping is overrated. I get passion at my office with my work, or with my friends that I sometimes call or chat with—it’s not the same, and, boy, it would be exciting to have it with my spouse. But I spend more time with people at my office than I do with my spouse.”

Then there’s my friend Chris, a single 35-year-old marketing consultant who for three years dated someone he calls “the perfect woman”—a kind and beautiful surgeon. She broke off the relationship several times because, she told him with regret, she didn’t think she wanted to spend her life with him. Each time, Chris would persuade her to reconsider, until finally she called it off for good, saying that she just couldn’t marry somebody she wasn’t in love with. Chris was devastated, but now that his ex-girlfriend has reached 35, he’s suddenly hopeful about their future.

“By the time she turns 37,” Chris said confidently, “she’ll come back. And I’ll bet she’ll marry me then. I know she wants to have kids.” I asked Chris why he would want to be with a woman who wasn’t in love with him. Wouldn’t he be settling, too, by marrying someone who would be using him to have a family? Chris didn’t see it that way at all. “She’ll be settling,” Chris said cheerfully. “But not me. I get to marry the woman of my dreams. That’s not settling. That’s the fantasy.”

Chris believes that women are far too picky: everyone knows, he says, that a single middle-aged man still has appealing prospects; a single middle-aged woman likely doesn’t. And he’s right. Single women are painfully aware of this. I hear far more women than men talk about getting married as a goal to be met by a certain deadline. My friend Gabe points out that this allows men to be the true romantics; when a man breaks up with a perfectly acceptable woman because he’s “just not feeling it,” there’s none of the ambivalence a woman with a deadline feels. “Women are the least romantic,” Gabe said. “They think, ‘I can do that.’ For a lot of women, it becomes less about love and more about what they can live with.”

Not long ago, Gabe, who is 43, dated a woman he liked very much one-on-one, but he broke up with her because “she couldn’t be haimish”—comfortable—with his friends in a group setting. He has no regrets. A female friend who broke up with a guy because he “didn’t like to read” and who is now, too, a single mom (with, ironically, no time to read herself) similarly felt no regrets—at first. At the time, she couldn’t imagine settling, but here’s the Catch-22: “If I’d settled at 39,” she said, “I always would have had the fantasy that something better exists out there. Now I know better. Either way, I was screwed.”

The paradox, of course, is that the more it behooves a woman to settle, the less willing she is to settle; a woman in her mid- to late 30s is more discriminating than one in her 20s. She has friends who have known her since childhood, friends who will know her more intimately and understand her more viscerally than any man she meets in midlife. Her tastes and sense of self are more solidly formed. She says things like “He wants me to move downtown, but I love my home at the beach,” and, “But he’s just not curious,” and “Can I really spend my life with someone who’s allergic to dogs?”

I’ve been told that the reason so many women end up alone is that we have too many choices. I think it’s the opposite: we have no choice. If we could choose, we’d choose to be in a healthy marriage based on reciprocal passion and friendship. But the only choices on the table, it sometimes seems, are settle or risk being alone forever.That’s not a whole lot of choice.

Remember the movie Broadcast News? Holly Hunter’s dilemma—the choice between passion and friendship—is exactly the one many women over 30 are faced with. In the end, Holly Hunter’s character decides to wait for the right guy, but he (of course) never materializes. Meanwhile, her emotional soul mate, the Albert Brooks character, gets married (of course) and has children.

And no matter what women decide—settle or don’t settle—there’s a price to be paid, because there’s always going to be regret. Unless you meet the man of your dreams (who, by the way, doesn’t exist, precisely because you dreamed him up), there’s going to be a downside to getting married, but a possibly more profound downside to holding out for someone better.

My friend Jennifer summed it up this way: “When I used to hear women complaining bitterly about their husbands, I’d think, ‘How sad, they settled.’ Now it’s like, ‘God, that would be nice.’”

That’s why mothers tell their daughters to “keep an open mind” about the guy who spends his weekends playing Internet poker or touches your back for two minutes while watching ESPN and calls that “a massage.” The more-pertinent questions, to most concerned mothers of daughters in their 30s, have to do with whether the daughter’s boyfriend will make a good father; or, if he’s a workaholic, whether he can provide the environment for her to be a good mother. As my own mother once advised me, when I was dating a musician, “Everyone settles to some degree. You might as well settle pragmatically.”

I know all this now, and yet—here’s the problem—much as I’d like to settle, I can’t seem to do it. It’s not that I have to be dazzled by a guy anymore (though it would be nice). It’s not even that I have to think about him when he’s not around (though that would be nice, too). Nor is it that I’m unable to accept reality and make significant compromises because that’s what grown-ups do (I can and have—I had a baby on my own).

No, the problem is that the very nature of dating leaves women my age to wrestle with a completely different level of settling. It’s no longer a matter, as it was in my early 30s, of “just not feeling it,” of wanting to be in love. Consider the men whom older women I know have married in varying degrees of desperation over the past few years: a recovering alcoholic who doesn’t always go to his meetings; a trying-to-make-it-in-his-40s actor; a widower who has three nightmarish kids and who’s still actively grieving for his dead wife; and a socially awkward engineer (so socially awkward that he declined to attend his wife’s book party). It’s not that these women are crazy; it’s that the dating pool has dwindled dramatically and that, due to gender politics, the few available men tend to require far more of a concession than those who were single when we were younger. And while I have a much higher tolerance for settling than I did back then, now I have my son to consider. It’s one thing to settle for a subpar mate; it’s quite another to settle for a subpar father figure for my child. So while there’s more incentive to settle now, there’s less willingness to settle too much, because that would be a disservice to my son.

This doesn’t undermine my case for settling. Instead, it supports my argument to do it young, when settling involves constructing a family environment with a perfectly acceptable man who may not trip your romantic trigger—as opposed to doing it older, when settling involves selling your very soul in exchange for damaged goods. Admittedly, it’s a dicey case to make because, like the divorced women I know who claim they wouldn’t have done anything differently, because then they wouldn’t have Biff and Buffy, I, too, can’t imagine life without my magical son. (Although, had I had children with a Mr. Good Enough, wouldn’t I be as hopelessly in love with those children, too?) I also acknowledge the power of the grass-is-always-greener phenomenon, and allow for the possibility that my life alone is better (if far more difficult) than the life I would have in a comfortable but tepid marriage.

But then my married friends say things like, “Oh, you’re so lucky, you don’t have to negotiate with your husband about the cost of piano lessons” or “You’re so lucky, you don’t have anyone putting the kid in front of the TV and you can raise your son the way you want.” I’ll even hear things like, “You’re so lucky, you don’t have to have sex with someone you don’t want to.”

The lists go on, and each time, I say, “OK, if you’re so unhappy, and if I’m so lucky, leave your husband! In fact, send him over here!”

Wednesday, March 10, 2010

Years and years in emergency medicine have given me a very enlightening look at the various specialties that make up the ‘house of medicine.’ I am constantly amazed by the other professionals I meet. It astounds me that pediatricians can manage the tiniest of humans, barely larger than my palm. I am fascinated by the way an orthopedic surgeon can look at a fracture and reconstruct it in her mind; a kind of spatial organization totally foreign to my cerebral hemispheres.

General surgeons can navigate the complex plumbing of the human body and leave it running smooth as silk after injury or cancer. And neurologists are at home with the awe-inspiring, labyrinthine pathways of the human brain.Internists and family physicians have the patience of Job himself, and radiologists can detect subtleties in gray shades that would leave an owl shaking his feathery head in wonder. There are so many amazing specialists, from intrepid obstetricians to ophthalmologists who apply optic physics to aging eyes.

Sometimes, I look at the talent all around me and wonder if I even belong in their world! I could not do what these people do. They impress me, for I do not have their talents. I am not like them! And yet, year after year, people say to me, and to you my readers, ‘I understand what you’re going through, I’ve done some emergency medicine!’

What exactly does that mean? ‘I’ve done some emergency medicine?’ Maybe I’m a little sensitive, but it’s always said with a kind of swagger that says, ‘Yep, anybody can do that; wasn’t challenging enough, so I decided to become a neurosurgeon!’‘I’ve done some emergency medicine,’ usually means that someone worked in a ‘moon-lighting’ capacity. Or that they rotated through an emergeny department. Or that, while between jobs, they found an emergency department or urgent-care clinic where they could make some money until they actually became ‘real doctors.’.

Imagine the laughter if we returned the favor. ‘Yeah, I’ve done some heart surgery; you know, back when I was an intern and needed the extra money!’ ‘Cool, radiation oncology! I did some of that when I was between emergency departments!’ ‘Angioplasty? Sure, I did some in school. It was kind of cool, but it wasn’t for me.’ We’d be laughed out of the room.So what makes everyone feel that emergency medicine is the thing anyone can do? I can tell you, at almost 20 years in the field, I have no idea what would possess someone to think our work was a kind of ‘medical default,’ available to any physician who could fog a mirror with their breath.

What makes us unique? If it is merely the ability to take punishment, day after day, week after week and year after year, well that’s enough to separate us from the majority of the pack. We can do that. We are the ones who alway take up the excess. When an office is full and a febrile child needs to be seen, that child is ours. When a surgeon is too busy to evaluate the complication, we get the pleasure. When the cardiologist’s patient codes during the stress test, like as not they’re sent to the emergency department. And when all of it happens simultaneously, just as four multiple trauma patients roll in, we still have to ‘medically clear’ the psychiatric commitment, and contend with the fact that other specialists are just too busy to come and help; despite their prior months of extensive ED experience.

But it’s more than that. Just as each variety of specialist has unique capabilities that are their trademarks, so do we. We think quickly, and make remarkably good decisions with a terrifying paucity of data. Our patients are mostly people we ‘don’t know from Adam’s house-cat,’ to use a lovely Southernism. Despite that, we are so good at snap evaluations that we can typically find at least the very bad things people have in time to intervene appropriately. We put the ‘M’ in multi-task; each room we enter may hold disease entities as varied as pulmonary embolism and hang-nail; but we can’t make light of any of it, since hang-nails may be MRSA infections, and what we thought was pulmonary embolism may also be cocaine addiction or drug-seeking.

We are masters and mistresses of negotiation, creativity and disposition. Our daily skill sets involve cajoling the anxious and insistent to be discharged, the drunk to sit still and the administrator to listen to our ideas. We must convince annoyed staff physician to admit the vague abdominal pain patient, and explain to the patient’s lawyer brother that we’re really doing a bang-up job. It isn’t that we are fiction-writers or deceivers, we are simply trying to weave the stories of the day into one great happy ending. And that requires some creative communication.

There’s more, and it’s only a partial list. We are expected to intubate through vomit, obtain IV access in the violent and delerious, wrestle and restrain the suicidal, splint the fracture, read most of our own X-rays (even as someone else is being paid to do it) and close the vast scalp-wound as the Meth junkie curses us. Our list of skills is long. But we have to do all of it while doing screening exams, sexual assault exams and ‘pre-incarceration’ exams. We have to do it all while everyone else looks over our shoulders with clip-boards, asking why we weren’t faster, why we weren’t more efficient, why we didn’t document more and why we didn’t spend more time at the bedside. We’re queried about why we gave so many pain pills, and why we didn’t give more pain pills; about why we paged when we should have called, and called when we should have paged. And all of it while all hades breaks loose around us.

Despite being considered the inbred mountain-folk of medicine, our talents are considerable. And most of them we learned by doing over, and over, for years at a time. We didn’t become experts by moon-lighting.I have to say, most people who tell me ‘I used to do some emergency medicine,’ really didn’t. At least, not the way we do it. Not with the same dedication, long-suffering and skill. If they had, they would have hugged us and apologized for not bringing lunch. And more importantly, they would have been ashamed to make the comparison. Not because they’re bad. But because we’re so good.

Tuesday, March 9, 2010

Usually i try to steer my conversations away from unhappy stuffs. I don't like to carry these unhappy feelings and unload them in other people's mind. Let the trouble be mine and my own. No one likes an old bus with a trailing toxic fume that suffocates.

But i haven't felt so angry for a long time that i need to vent. And i can't pinpoint what was it that pissed me off. I wasn't proud of myself.

I thought i had a firm control on my temper, that i can take all kinds of shit. These 4 months in A&E kinda reinforced my belief, seeing all sorts of people and getting all kinds of insult hurled at me. I had so far maintained this zen-like smile (my imagination anyway, haha) rather effortlessly.

I never got worked up by whatever scathing comment i had gotten so far, since most of them were either intoxicated or completely out of their mind. I didn't in any way identify with the labels, and i didn't suspect in the faintest likelihood that they could be right anyway. I could laugh them away and frankly, i probably did not get that many of them anyway.

I raised my voice at the patient's family today. Tsk tsk, extremely not skilful.

The patient (himself quite apologetic) had been waiting for 3 hours for a bed, but unfortunately bed situation in my hospital after the chinese new year period has been like a bad drought. The family requested for an update, and soon started raising their voice at me as i approached the reason for the delay. Despite reassurance that we were doing all we can to comfort him in the interim while waiting for his bed (and the busy inpatient ward MO), they were unhappy that the nurses were unable to secure a bed sooner. As soon as i told them that post CNY a lot more patient had showed up en masse, hence the bed crunch, they accused me of giving them an excuse.

How the hell is that an excuse? (I said, that's an explanation! Aghast!)

No you are not giving me an explanation, you are giving me an excuse!They were relentless. They weren't listening.

I should have recognised that earlier. I should have just kept my mouth shut and act dumb. But i kept trying to drill some sense into them, to no avail.

In the end i found myself with boiling temperature blood coursing through my body, and my ears must have been red like a chimpanzee's ass.

How the confrontation ended i could not remember clearly now. I guess it was Ramizah who came to my rescue, diverting some of their firepower.

Why are people with absolute no idea of hospital's logistics so liberal at throwing their judgement about a hospital's seeming inefficiency? Does being family to a patient grant you the right to misbehave and boss around?

'Why are you raising your voice at me?' I said it in the calmest possible manner. What i got was 'i am not raising my voice at you' in an increasing high pitch and amplitude, and the whole observation ward was looking at us.

I guess what i felt was betrayal. That caused the anger.

Why do families turn their back against us healthcare worker who are trying to help the patients fighting against our common enemy, the diseases and sufferings? Aren't we supposed to be in the same team? (I was foolish to think so, guess i am not jaded yet)

I stayed back for almost 2 hours after work to sort out my patients, and all i got are these lousy people who don't appreciate what we are doing, threatening/deciding to AOR but have no pride to stick to their ill-decision to the end. Even have the cheek to ask the nurse to tell me they want to stay anyway in the end, and to cancel AOR.

We are all trying our best, why can't these people just make our hard work a little more pleasant/easier?

*The saving grace is that i can recall at will many more angelic patients who genuinely appreciate our sacrifice and makes all these self -denial (of pleasures) so palatable that i won't mind doing it till all my teeth fall

**What do you expect? Life's like that. Didn't you read the fine print when you sign on?

Wednesday, March 3, 2010

An irate family yelled at the top of his lungs and launched into a tirade of abuse against the nurses, exasperated that despite his mother's call bell rang twice, there was no one attending to her bursting bladder.

Nevermind a nursing senior tried to placate him and had apologised profusely, he became more abusive in language. A young nurse saved the day by bringing in a bedpan, averting a potential major disaster where the patient floods the entire emergency room with her huge volume of urine produced over the eternity of last 30 minutes (a nurse attended to her barely half an hour ago), drowning those who had the misfortune of devoting their life to medicine and nursing in the emergency room, along with the other patients...

'WHAT KIND OF SERVICE IS THIS?!'

Folding his arms and flushed with anger, he majestically glared at the healthcare minions that scrambled at his roar.

I had the misfortune of being his mother's attending doctor. But that did not stop me from being indifferent. I walked away to see another patient, to save a life potentially, rather than getting tangled up in PR mess.

Some people are just impossible.

How do you rate a hospital's service?

What is the benchmark that you judge the quality of your hospital experience against?What, really, is your expectation of an emergency department?What, do you make of nurses?

Dear friends, please bear in mind that a hospital is neither a restaurant or a hotel.

A hospital's primary purpose is to care for the sick (all of them, which in a busy emergency department like ours, amount to at least 500 patients a day), and when resources are adequate, secondarily we try to keep everybody happy and satisfied while at it.

Contrast this to other major service industries where customer satisfaction takes a whole lot more importance. Theirs are industries revolving around expendable needs and luxuries, where they are free to outprice low-income segments just to afford the level of services expected of them.

Hospitals just cannot afford to behave like hotels, restaurants, or airlines.

Consequently, nurses are not there to serve your every fancy and need at the flick of your finger like waiters or bellboys that subsist on your goodwill and tips. Theirs is a profession to serve sick people in need. Caring and tending to people with genuine health issues is their calling.

They are not your butlers/waitresses/cabin crew/cleaners/janitors. So do not expect the same service from my nurses.

Your average waitress doesn't wipe your bottom when you lose control of your asshole, does she? She probably will scream at you, get disgusted, and throw you out of the door.

Your average hotel concierge won't entertain you if your wallet is bone bare, save checking you into a room. Money comes first, your need will only be met as much as your credit limit allows for. Nurses don't give a fiddler's fart about how poor you are. As long as you are sick, you are their patients.

So if you want to boss around, go to Resorts World. If you are sick and you still want to boss around, try private hospitals.

However, if you end up in a government restructured hospital, please remind yourself that we are spreaded extremely thin with limited resources, and we have no choice but to do some serious prioritization all the time. In another word, we decide what is important and gets our attention first, not you. Some tasks will just have to wait, within reasonable confines of course.

We cannot attend to a bursting bladder and a blocked heart with the same urgency just to keep you happy. You cannot afford to have us do so too. Think about it.

Tuesday, March 2, 2010

I have seen many similar XRs before but little did i suspect one day i will have the fortune of seeing one myself.

So far, i notice a unifying theme in their presentations.

It's usually a fall landing on buttock.Somehow there's a cylindrical object of considerable girth that happens to be sitting upright on the floor at the point just where the anus will eventually end up at.Somehow the cylinder stays resolutely still in the face of a crashing asshole, rather than tumbling aside as i would expect.Somehow the cylinder has such a smooth entry into the rectum that there's absolutely no evidence of external injuries/tear around the abovementioned orifice. I mean, we are all a bunch of tight ass-ed people aren't we?And sometimes, somehow, after retrieval of the object, there's a condom sitting over the top of the cylinder that the patient conveniently forgets to tell you about.

Come on, just tell us upfront what you were up to. The cylinder may look like a rocket, but it definitely isn't a rocket science to figure out.

Honesty is the best policy. My sympathy takes a free fall down the vertical cliff the moment you try to convince me of the plausibility of the above Somehows.

Recently i have been thinking about resuming writing here more and more.

It strikes me hardest when i was returning from Penang after my brief Chinese New Year holiday. The moment i boarded the plane, looking at the plastic smile pasted over the cabin crew faces, i was awashed with emotions. For the umpteenth time i am leaving Penang, i still feel the reluctance. I want to put these feelings into words, immortalising it, so that one day i can return and read what i felt, checking it against what lingers on in my memory.

We forget all the time. We whitewash our past since we were first born. It's our inherent nature.

I want to remember today as it is, and be able to relive the moments from my writings.

I guess this qualify as an emo post. Haha. It's almost 2am now and i am having insomnia.